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The NHS faces a slow road to recovery and the government must manage expectations to retain public confidence.

That is the message from the NHS Confederation in a report published yesterday (Wednesday 10 June). It warns that the health service in England faces an uphill battle as it continues to manage thousands of very sick and recovering COVID-19 patients, maintain social distancing and restart services to treat cancer, stroke and heart care. 

This challenge will be made harder as healthcare services will be operating with much reduced capacity – possibly around 60 per cent of normal because of the need for infection control measures, including the need to adhere to social distancing measures for patients and staff.

Among the key challenges will be dealing with the backlog of treatment that has been put on hold during COVID-19, with the waiting list for routine procedures already at more than 4 million now certain to rise significantly.  As the pandemic moves from an ‘emergency’ response to ongoing care and rehabilitation, patients will require social care, respiratory, psychological, and other treatment in the community.

Analysis shared with the NHS Confederation suggests that the NHS waiting list could reach 10 million by the end of the year, possibly higher if there is a second wave of COVID-19 and a lack of treatment or a vaccine.

Doing all of this, health leaders will have to support many exhausted and traumatised staff and stay prepared for a possible second peak. They remain concerned that further steps to ease the lockdown must have a robust and clear rationale and be communicated with proper assurances to NHS staff and the wider public. This will include assurances about the effectiveness of the test and trace programme and adequate supplies of protective equipment as services restart.

In an accompanying letter to the Prime Minister, the NHS Confederation warns that it will not be possible to simply ‘switch on’ NHS services immediately. It calls on the government to manage expectations about how quickly key patient services can be restored and to communicate this clearly if public confidence in the service is to be maintained.

Based on engagement with its members, which span services that commission and provide healthcare, including primary care, the report sets out some of the ways in which local NHS organisations will need support to get the NHS back on track – many of which require local health and care partnerships to be empowered to oversee transformative change. It also calls for a commitment to support local government and social care services without which the NHS in England cannot function effectively.

It calls for:

• An extension of emergency funding across all sectors of the NHS, given significant extra demand across all services. Longer term funding will be needed for rehabilitation and recovery services in the community, including for mental health, to manage  patients at home and in the community.
• Putting in place an ongoing arrangement with the private sector – this will be vital to provide capacity to respond to the backlog of treatment.
• A review of the impact of COVID-19 on the NHS and social care workforce given the unprecedented pressure staff have been under
• A delay in returning to the inspection regime of the CQC to take into account the positive changes that have been achieved as a result of the lighter touch approach to regulation that has been in place during the pandemic.
• A commitment to acknowledge and address health inequalities wherever possible through upcoming guidance and policy reform.
• Clarity over when there will be a return the greater autonomy local organisations had before COVID-19 returned, as we move from Level 4 to Level 3. This should be considered as part of a wider move to less central command and control when the pandemic has subsided.
• A call for assurance that there will be a fully operational and robust test, track and trace system, as well as appropriate supplies of personal protective equipment (PPE),as services are resumed.

The NHS Confederation has published its report ahead of updated guidance from NHS England and NHS Improvement on how the next phase of the NHS response to the pandemic will be managed.

Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said:

“NHS leaders understand the need to ease lockdown and get the country ‘back to work’. Part of this will involve restarting diagnostic screening, routine operations, outpatient appointments and other care, but we need to do this safely. Our members are aware that the virus is still with us and of the real risks of outbreaks in care settings. That is why we need a robust plan, communicated clearly, and trace  to make sure the NHS can prepare safely, protecting its staff, patients and the wider community as it does so.

“Political leaders have a vital role to play in reassuring the public that every step possible is being taken to manage the virus, while safely bringing back services that had to be paused. Retaining, public confidence and trust in the NHS will be vital over the next few months.

“The NHS wants to get back to providing these vital services - the virus has inflicted pain and suffering throughout the UK, but we also know the measures to combat it have come at a terrible cost to those who have not been able to access the care, treatment and support they need and to many whose conditions have gone undiagnosed.

There is a real determination to rise to this challenge, but it will need  extra funding and capacity, not least in rehabilitation and recovery services in the community where so much of the coming demand will be felt.

“But we also need to send a clear message that it will take time to recover from this shock and we need patience and understanding and from politicians, assurances, support and realistic expectations.”

This report is the second from the NHS Confederation’s NHS Reset campaign, which aims to contribute to the public debate on what the health and care system should look like in the aftermath of COVID-19.